Medical Malpractice

In this article we discuss the medical diagnoses underlying the most common lawsuits involving pediatricians in the United States. Where applicable, specific and general risk-management techniques are noted as a means of increasing patient safety and reducing the risk of medical malpractice exposure.

Le sentenze della Cassazione intervenute fino al 2012 qualificano come lesione od omicidio il trattamento arbitrario
ad esito infausto o comunque implicante menomazioni non funzionali allo scopo di cura; in caso di
accanimento terapeutico, si ritiene che il consenso del paziente non possa fungere da scriminante.
Su un diverso fronte, il Parlamento stava allora per approvare un d.d.l. in tema di dichiarazioni anticipate
di trattamento, volto a ridimensionare drasticamente l’autodeterminazione del paziente, specie se
incosciente, e l’autonomia terapeutica del medico, in nome della salvaguardia in ogni caso della
salute e della durata della vita. Il testo, per la sua dissonanza rispetto a principi fondamentali, sollecitava interpretazioni correttive costituzionalmente orientate e questioni di
costituzionalità, che in questo contributo già tentavamo di abbozzare

La inmediata conexión con los errores médicos suele ser un tema de gran sensibilidad como es la denominada “mala praxis médica”, ya que genera discusiones entre profesionales de la salud y abogados, y sobre el cual nos urge delinear algunas alternativas para su gestión –como uno de los tipos de conflictos que aborda la conflictología sanitaria-, mediante la combinación de los principios del Derecho de la Salud y los métodos de resolución alternativa de controversias (RAC).
Nos hemos ocupado de describir el fenómeno que se ha instalado en nuestra sociedad, que se lo conoce como “judicialización de la salud” o, como lo denomina el académico Víctor Abramovich, la “rutinización” de los reclamos vinculados con el derecho a la salud interpuestos por pacientes que procuran obtener la protección judicial de su derecho.
Y en el tipo de conflicto que nos ocupa -que involucra al equipo de salud y a los pacientes- se habla de “mala praxis médica”, “industria del juicio”, “caranchos de la salud”, “enfermedad de la judicialización”, “Síndrome Judicial” y hasta “Justicia terapéutica”. Se encuentra asimismo  en la tabla de materias del fuero civil y comercial del Poder Judicial de la provincia de Buenos Aires como “Daños y perjuicios por responsabilidad profesional”.
Según el estudio de la mediación prejudicial obligatoria realizado por el Programa de Naciones Unidas para el Desarrollo –Argentina y la Fundación Libra, “la cantidad de juicios por mala praxis médica aumentaron anualmente a partir del año 2003. Esta alza podría estar relacionada con el mayor conocimiento por parte de la población de la posibilidad de realizar su reclamo en el marco de la figura de mala praxis. Puede mencionarse que la difusión masiva de este concepto es relativamente reciente al haber aumentado la importancia de los sectores proveedores de servicios profesionales en el marco de la economía nacional.
De acuerdo con los datos de la Superintendencia de Seguros de la Nación se ha observado que la estructura de la cartera de juicios (incluyendo mediaciones abiertas) al año 2009 es de 147.468 siniestros, con preponderancia de los ramos automotores (65,4%), seguido por el transporte público de pasajeros (16,8%) y luego por responsabilidad civil (11,5%), que en conjunto representan el 93,7%.
La opinión de las compañías que se dedican a seguros de responsabilidad civil por praxis médica, sostiene el valor de la mediación y no manifiestan dificultades respecto del cálculo de la reserva, que desde octubre de 2009 se cambió por disposición de la SSN. Consideran que la instancia de mediación prejudicial obligatoria otorga la oportunidad de hacer un análisis de viabilidad jurídica, lo que genera un nivel interesante de reclamos que se desisten. Se pronuncian a favor de “nacionalizar la mediación” haciéndola obligatoria y previa al juicio en las restantes provincias. Correlativamente, de los datos proporcionados por la SSN se aprecia que el porcentaje de mediaciones que se desisten alcanza al 25% de las iniciadas, mayor que el 15% correspondiente a los reclamos relacionados al automotor.”
Ello nos lleva a presentar algunas conceptualizaciones iniciales para llegar a comprender el núcleo central de esta propuesta.

This study was carried out in Musanze District, Northern Province of Rwanda. The general objective was to assess the status of medical negligence and malpractice in Musanze District, Rwanda. Both primary and secondary data were collected. Questionnaire survey was used for primary data collection where purposive sampling was used. Secondary data were gathered from books, report, journals, magazines and internet. The collected data were analyzed by using Microsoft excel package.  The majority of respondents (88%) admitted to have been involved, witnessed of dealt with medical negligence and/medical malpractices case where only 14.7% of stated that the cases were taken to court. The majority of respondents, especially patients perceive the medical negligence and malpractice as a critical issue, whereas most of respondents are moderately aware about the rights to medical care (45%) in addition to 25% of respondents who are very aware about the rights to medical care. Most of respondents (37.5%) especially the patients ignore the laws governing medical negligence and malpractice. The majority of respondents (60%) perceive the existing laws as weak while as the majority of respondents (74%) think that the existing laws are rarely applied in case of medical negligence and malpractice. The main factor contributing the medical negligence and malpractice is the “scarcity of medical practitioners” (90%) followed by “other health priorities” (80%), poor training of practitioners (54%), law deficit (50%) and public ignorance (46%). The main perceived effect of the medical negligence and malpractice on victims is the “loss of trust in medical practitioners” (100%) followed by “condition worsening” (90%), defensive medicine (62%) and psychological damages (20%). The most frequently perceived solution would be “the effort by medical practitioners to reduce harm” (74%) followed by “awareness campaign” (62%), “improved communication” (62%) and “law enforcement” (28%). The study concluded that the current situation of medical negligence and malpractice is critical. The majority of service users ignore the existing laws; the main factor contributing the medical negligence and malpractice is the “scarcity of medical practitioners”; the most frequently perceived solution to medical negligence and malpractice would be “the effort by medical practitioners  to reduce harm and has recommended further researches and the empowerment of regulation organs and bodies, the organization of education and awareness campaigns about the existing laws, the increase the number of health practitioners and training of them on how to reduce harm to patients.

Sažetak: Zdravlje ljudi je krivičnim zakonodavstvom predviđeno kao važan zaštitni objekat. Iako je cilj u radu svakog ljekara poboljšanje zdravlja i izlječenje pacijenta, ponekad dođe i do slučajeva ljekarske greške. Autor u radu najprije razmatra definisanje pojma ljekarska greška, osvrće se na osnovnu podjelu i razdvaja pojam ljekarske greške od sličnih pojmova kao što su nesrećan sučaj i komplikacija. Ljekarska greška postojaće u slučaju ako se utvrdi uzročna veza između radnje ljekara i ozbiljnog narušavanja zdravlja pacijenta ili nastupanje smrtnog ishoda. Da bi izbjegao da dođe do ljekarske greške doktor je dužan da pacijentu objasni eventualne rizike u liječenu, kao i rizike u toku samog operativnog zahvata i postoperativnom toku, kao i da pacijent da saglasnost prije medicinskog zahvata. Autor dalje razmatra konkretno krivično djelo-Nesavjesno pružanje ljekarske pomoći i analazira ga u pozitivnom pravu i krivičnom pravu Slovenije gdje dolazi do interesantnih zaključaka o sličnosti propisanih sankcija kao i da je krivično djelo-Nesavjesno pružanje ljekarske pomoći delicta propria, jer je sužen i specifičan krug onih lica koje se mogu naći u ulozi izvršioca krivičnog djela. Ključne riječi: Ljekarska greška, nesrećan slučaj, komplikacija, nesavjesno liječenje bolesnika, nesavjesno pružanje ljekarske pomoći, pristanak pacijenta 1.

Barriers of many different types make successful circumcision-related
lawsuits extremely difficult to bring. Actual cases we and others have brought show that among factors impeding progress are (1) financial risks; (2) procedural difficulties; (3) misconceptions and compassion misallocation among judges, lawyers, jury members, the media, and the general public; (4) constraints unique to circumcision lawsuits that are imposed by statutes of limitation and statutes of repose; (5) need for parental participation in lawsuits; (6) problem of damages not being atrocious enough to justify litigation; and (7) the scarcity of helpful case law. Players whose roles we will be scrutinizing include clients, lawyers, judges, juries, courts and procedures, doctors, media, and fellow activists. We will discuss the many reasons why potential plaintiffs never even make it to the filing stage. We will look at why
judges and juries are starting to understand that just having a foreskin is not reason enough to have a circumcision.

"Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDS-three causes that receive far more public attention" (Kohn, 2000)

While dozens of studies now show a bra-cancer link, breast cancer research is still routinely ignoring bras. In fact, the discussion of the bra-cancer link is taboo in medicine, for political and economic reasons. This paper discusses the reasons why this issue is being suppressed and censored by the medical community, and describes a new study from Iran that is breaking through the wall of silence and pointing to a revolution in the breast cancer field.

How do you know when medical news is fake?  Can you trust what you read simply because it comes from an allegedly reputable source?

Surely, you can trust information coming from the American Cancer Society, right? 

Wrong!

The case in point: the link between breast cancer and bras.

This writing analyzes, from a diachronic point of view, medical malpractice and how it has been impacted by the Italian law 8 March 2017, n. 24. The study shows that recognizing doctors directly liable in tort (art. 7) introduces a separation between form and substance. This separation arises problems of constitutionality in “intramoenia” cases and of juridical qualification regarding the relationship between doctors and healthcare facilities. There are also some critical issues about compulsory professional insurance rule (art. 10); some of them would have been avoided by providing an equivalent obligation for insurance companies. Finally, hospitals’ and insurance companies’ right of redress (art. 9) seems inconsistent, because it presupposes a discretionary power to doctors, which has been denied, in general, by the law.

In reply to the letter by Birkeland,1 who commented on
our paper entitled ‘Punishment for medical malpractice
in Japan’,2 we discuss the two sides of medical safety,
protection of healthcare professionals and patients’
safety.

Intern Med J. 2016 Sep;46(9):1118-9. doi: 10.1111/imj.13189.

Gelişen teknolojinin zaman içerisinde
radyoloji teknikerleri yüksek oranda beceri, teknik bilgi gerektiren işleri yaptıkları görülmektedir.
Radyoloji profesyonellerinin aktif olarak radyoloji ve girişimsel radyoloji bölümünde çalışmaları
kaliteli hizmetin sunulabilmesi için bütüncül bir yaklaşımla kaliteli sağlık hizmeti sunumunu
gerçekleştirmeleri gerekmektedir. Bu makalenin yazılmasındaki temel dayanak, gelişen teknoloji ve
tıbbi yeniliklerine uyumlu olarak mesleki ve eğitim müfredatının uluslararası alanda radyoloji
profesyonelleri olarak bir bütün olarak çalışma ortamlarını ve akademik çalışmalarının yapılmasının
önemine vurgulanmaktadır.
Radyoloji

While rare in Scandinavia and Europe, male circumcision is still common in North America despite some reductions in frequency over recent decades. The United States rate has declined from 90 to 60 per cent in recent years and has fallen by 15 percent in five years.1
Canadian circumcision rates differ dramatically from province to province but the national average is around 25%. It is revealing that the provincial rates have plummeted as each province discontinued coverage under the National Health Service.2
Currently, only Manitoba still pays for circumcisions. Circumcision does not constitute genuine medical treatment. It violates criminal law, the
Canadian Charter of Rights and Freedoms, and also human rights. The health implications are graver than is generally realised, despite clear medical evidence of adverse effects from the pain, significant complications, psychological harm and inevitable prejudice to genital
function. There are no clearly demonstrable medical benefits. The law, the medical profession, and society in general seems to have turned two blind eyes to this serious form of violence against males.

Una valutazione critica dell'interessante paradigma della "competenza per il rischio", che grazie ad alcune sentenze della quarta sezione si sta affermando nella giurisprudenza della Cassazione, quale criterio di ripartizione delle responsabilità in caso di contributo plurisoggettivo o cooperazione della vittima alla realizzazione di un fatto di reato, in specie nei settori della responsabilità penale del medico e per infortuni sul lavoro. Segue una proposta alternativa di interpretazione dell'art.41, cpv., c.p. (concause sopravvenute da sole sufficienti a determinare l'evento), e un invito a valorizzare il momento di "colpevolezza" dell'illecito colposo, quale requisito insostituibile per garantire una ascrizione di responsabilità davvero rispettosa dell'art.27 Cost.

L’art. 2236 c.c. rappresenta ormai da decenni un costante punto di riferimento delle ricostruzioni rela- tive alla colpa penale di chi esercita una professione sanitaria. Tanto la c.d. legge Balduzzi quanto la c.d. legge Gelli-Bianco hanno tentato di stabilizzare due dei pilastri attorno ai quali ruotano la lettera e l’interpretazione dell’art. 2236 c.c.: la colpa grave e la colpa per imperizia. Le categorie di derivazione civilistica, tuttavia, sembrano costituire un fattore di dannoso immobilismo, sminuendo le potenzialità insite nella sistematica della colpa penale che, da sole, potrebbero valere a “superare” alcuni degli orien- tamenti giurisprudenziali più criticati.
Un’indagine relativa alle origini civilistiche dell’imperizia come unica limitazione della colpa medica evidenzia come gli schemi in questione non siano del tutto riferibili anche al sistema della responsabilità penale, all’interno del quale la tendenza costante è stata quella di svalutare la distinzione tra le “forme” di colpa ricavabili dall’art. 43 c.p. L’esplicita menzione della colpa per imperizia nel nuovo art. 590- sexies c.p. obbliga però l’interprete a un più accurato sforzo definitorio e classificatorio, al fine di verifi- care se la nuova disposizione sia in grado di ritagliarsi un autonomo spazio applicativo o se sia destinata a soffocare, avvolta dall’autentica camicia di Nesso in cui si è trasformato l’art. 2236 c.c.

Medical malpractice lawsuits in terms of its legal aspects, involving a “breach of contract”, “infringement of patient right”, or “the negligence of duty of care”. In its substantive level, mainly due to the patient's health, body as well as the right to life had been violated because of doctor’s medical behavior, the developments and results of the course of diseases were unexpected, and the discordance between doctor-patient relationships. According to the statistics made by High Court, three to four hundreds of medical malpractice cases were moved to local courts each year, whereas only less than 20 percent civil cases were recovered, and the recovered ratio of criminal cases were even lower. Regarding the low rate of compensation in respect of giving plaintiffs’ revenge, three dimensions can be deliberated: either the medical techniques need to be improved; or the litigation structure with respect to medical dispute should be reformed, or the ethical attitudes and reflections on medical malpractice resided in agents involved should be elucidated. This article aims to analyze and discuss the ethical perspective of medical malpractice with the hope that we can find some clues about how to think righteously and take appropriate reactions for those who involved in medical dispute.

Il tema della responsabilità nell’esercizio professioni sanitarie ha assunto in questi anni un grande rilevo per la complessità degli interessi e delle posizioni coinvolte, oltre che per la difficoltà di interpretazione del disposto normativo che tende ad alleggerire la responsabilità dell’operatore medico in ambito penale, mantenendo invece, in ambito civile, inalterati i confini della responsabilità e della risarcibilità del danno subito.

Il paziente dovrà provare l’esistenza di un contratto e l’aggravamento della situazione patologica, restando a carico del sanitario, la prova che la prestazione professionale è stata eseguita con l’adeguata diligenza e che l’aggravamento deriva soltanto da eventi imprevedibili.

Partendo da un’analisi dell’ampia casistica esistente e delle pronunce della giurisprudenza di legittimità e di merito, gli Autori ricostruiscono le figure di danno in relazione alle varie professioni sanitarie, soffermandosi in particolar modo sui presupposti che costituiscono la fattispecie, sulla prova del danno ingiusto, dell'evento dannoso, del nesso causale, del fatto e sull'entità del danno subito.

https://shop.wki.it/Utet_Giuridica/Libri/La_responsabilita_medica_s582100.aspx

Health is a special area of interest of legislation and legal environment, as it has a special meaning for the entire community and  includes most of the disciplines of knowledge. Thus, its proper legal regulation is a very difficult and responsible task, as consequences of legal research in a scientific monograph.
The “Health law. Selected issues”  includes studies presenting the selected aspects of health law. Fourteen lawyers, representatives of science and legal practice, have shared the results of their research. The collective study has been divided into three parts: pharmaceutical law, medical malpractice and  varia. All of them are innovative and the aim is to present a broad area of health law interests.

Many people are recognizing that there are apparent contradictions in the official narrative about COVID-19 and vaccinations. If the vaccine is supposed to prevent infection, then:

Why are so many vaccinated people getting sick with COVID (breakthrough infections)?
Why are the unvaccinated a risk to the vaccinated?
Why is immunity short-lived and boosters needed?
Why vaccinate those who already have had COVID and have natural immunity?
Why do these vaccines leave the vaccinated so vulnerable to infection?

The answer is that these vaccines are not preventative vaccines; they are therapeutic vaccines. Everything we have been told about these vaccines makes sense once you realize that they are for treatment, not prevention.

This paper examines the principles and practice that should underline no-fault compensation schemes for medical injury. It draws on a critical examination of the McLean Report, which was commissioned by the Scottish government to examine whether such a scheme should be established in Scotland. Drawing on a restorative justice model, I argue that a principled approach a no-fault scheme for medical injury requires a redress package that is responsive to what patients say they want as a result of suffering harm through medical treatment. This should involve paying adequate financial compensation; providing appropriate apologies and explanations; and facilitating professional accountability and lesson learning in order to enhance patient safety and improve healthcare outcomes. Where this is not possible within the no-fault scheme itself, then at the very least a more ‘joined-up’ approach needs to be developed, which links the scheme to independent complaints procedures and professional disciplinary bodies. Ensuring that this redress package is provided offers the best chance of ensuring patient satisfaction with the scheme in the long term. Even if such reforms are implemented, the question remains as to whether aspiration will ever match reality. Based on a review of current schemes for medical injury, it is suggested that the full implementation of this type of redress package is likely to remain elusive in practice.

This report provides a literature review and comparative analysis of the advantages and disadvantages of no-fault compensation schemes (for medical injury) in New Zealand, Sweden, Norway, Denmark and Finland, as well as the limited schemes operating in Virginia and Florida in the United States.The report was prepared for the Scottish No Fault Compensation Review Group in 2010. The work and findings of the Group can be accessed at:http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/No-faultCompensation

Introduction: Through the developments in science and technology, in health-care services, roles and responsibilities of nurses are changing, and nurses are frequently faced with risky circumstances in terms of malpractice. In this case, it is thought that nurses may be inclined to exhibit defensive practices. Methods: This study was carried out in a descriptive type to determine the defensive practice status of nurses. The population of the study consists of the nurses working at a university and private hospital, and the sample comprises 345 nurses working at inpatient departments in hospitals. This study was approved by the ethical board of Istanbul Medipol University. Data were analyzed using SPSS 21.00. Results: About 91.9% of the nurses who were included within the scope of the research are female, and the mean age is 35.67 ± 8.89. It was found that 60.9% of the nurses, who were included within the scope of the research, sometimes had concerns about making a mistake in nursing...

Many well-known cases of ‘medical manslaughter’ have shown that systemic issues play a significant role in contributing to fatal errors in healthcare institu- tions. The most prominent NHS scandal, Mid Staffordshire, demonstrated that wrongful prioritization of resources and staff shortages had contributed to the deaths of between 400 and 1200 patients due to appalling care by nursing staff and doctors between 2005 and 2009. Following the scandal, the Trust was prose- cuted and convicted of a criminal offence under the Health and Safety at Work Act 1974 in 2014 and 2015. In contrast, in a scandal of comparable scale across the Channel, ‘the HIV-contaminated blood scandal’, individual decision-makers were subject to criminal convictions. Learning from features of the French crimi- nal process, and the aftermath of the 1980s French tainted blood scandal, this article argues that the criminal process can only be a useful response to health- care systemic failings if higher-level decision-makers are also included in the scope of criminal liability when they have recklessly endangered patients. When no individual reckless fault is found on the part of decision-makers, corporate criminal liability is a suitable alternative to individual criminal liability, if it is fo- cused on ensuring safety and offering justice to patients who have been harmed as a result of healthcare systemic failings.

The medical malpractice tort system is a failure. Judged on economic terms, more than fifty percent of the dollars are lost to transaction costs, and the instability of the market disrupts the orderly delivery of medical care. Judged on public health terms, it not only fails to provide incentives for better medical care, but its irrationality actually impedes the adoption

Tıp alanının” özne”si gibi “nesne”si de  İNSAN’dır. İnsanın karmaşık psikolojisi ve somatik fizyolojisi ve yaşadığı sosyal çevrenin sağlığın belirleyicisi oluşu tıbbı diğer bilimsel branşlardan ayırmaktadır. Ayrıca son yıllarda artarak tıbbın içine giren yüksek teknoloji insan kavramı üzerinde aşındırıcı/farklılaştırıcı bir değişimin kapılarını zorlamaktadır. Bu eğilimler son iki dekatta tıp eğitimi içinde “insan” ögesini öne çıkaran eğitim içeriklerini zorunlu kılmaktadır. Tıbbın  teknik tarafı ile sosyal bilimler arasındaki nadir köprülerden biri de etik branşıdır. Bu kitapta tıbbın tartışmalı bazı alanlarına etik yaklaşımların nasıl olabileceğine dair yaklaşımları bulacaksanız.

Le Sezioni unite penali della Corte di cassazione sono chiamate a pronunciarsi sulle questioni di diritto intertemporale determinate dall’introduzione dell’art. 590-sexies c.p. ad opera della l. n. 24 del 2017 (c.d. legge Gelli-Bianco), con contestuale abrogazione dell’art. 3 della l. 189 del 2012 (c.d. legge Balduzzi).

Si tratterà, in particolare, di chiarire se la nuova causa di non punibilità possa applicarsi anche ai casi di imperizia ravvisabile nella (sola) fase esecutiva della prestazione medica, a seguito di una corretta impostazione tanto della fase della diagnosi quanto di quella della scelta del trattamento.

Questa possibilità, esclusa (in maniera condivisibile) dalla sentenza Tarabori, è stata invece ritenuta ammissibile dalla sentenza Cavazza. Alle Sezioni unite, dunque, l’ardua sentenza.

L’udienza è stata fissata per il 21 dicembre 2017.

Pasien merupakan setiap orang yang melakukan konsulstasi terhadap profesi dokter mengenai masalah kesehatan tubuhnya untuk mendapatkan kesembuhan dari penyakitnya. Pasien merupakan raja dalam pelayanan kesehatan. Untuk mendapatkan kesembugan, seorang pasien akan di cek kesehatannya oleh seorang dokter yang telah membuka izin praktik. Pada pasal 44 Undang-undang No. 29 Tahun 2004 tentang praktek Kedokteran menyatakan "Dokter dan dokter gigi dalam menyelenggarakan praktik kedokteran wajib mengikuti standar pelayanan kedokteran". Dalam menjalankan tugas profesi, soerang dokter mempuunyai alasan yang mulia yaitu berusaha mempertahankan supaya kondisi tubuh pasien tetap sehat serta berusaha semaksimal tenaga untuk membuat sehat tubuh pasien, akan tetapi pelayanan kesehatan seorang dokter yang dilakukan kepada pasien tidak selama berhasil dengan baik dan memuaskan, tetapi ada kalanya usaha tersebut mengalami kegagalan, kerusahan organ tubuh, bahkan kematian pada pasien.Penelitian ini merupakan penelitian hukum yang menggunakan pendekatan yuridis normatif. Menurut Soerjono Soekanto penelitian yuridis normatif merupakan penelitian terhadap asas-asas hukum. Pendekatan normatif dilakukan dalam membahas Perlindungan Hukum Pada Pasien Terhadap Malpraktek Dokter Menurut Undang-Undang Nomor 29 Tahun 2004 Tentang Praktik Dokter agar dapat mencapai hasil yang signifikan dan relevan. Adapun data data yang digunakan yakni data primer yang berasal dari Instansi Instansi yang berwenang seperti Komnas Perlindungan anak yang kemudian didukung dengan data sekunder yakni literatur relevan untuk memperkuat analisis dari penelitian ini.Hasil penelitian dan pembahasan menunjukan bahwa perlindungan hukum bagi pasien terhadap malpraktek dokter dapat dilihat dalam Undang-Undang atau Kode etik profesi kedokteran. Selanjutnya untuk upaya hukum yang dapat ditempuh pasien adalah dengan jalur mediasi, apabila dalam mediasi tidak terselesaikan, maka pasien dapat menggugat apoteker pada pengadilan maupun di luar pengadilan. Kata kunci: perlindungan hukum, pasien, malpraktik.